Maria Laura Flori

Predictive value of skin color for illness severity in the high-risk newborn.

The relationship between skin color and illness severity in the newborn remains untested. We have evaluated the predictive value of skin color readings for illness severity in a population of high-risk newborn infants. A prospective study was conducted on 107 white newborns in the intensive care unit, which were categorized as either high or low severity of illness, defined by the presence of severe neonatal morbidity. Illness severity was also determined using a Score for Neonatal Acute Physiology (SNAP). Color readings were obtained at 10 different body sites using a portable tristimulus colorimeter during the first 24 h, and color was expressed using the standard CIE L*a*b* system. Skin CIE b* values were significantly lower in the high severity group (p < 0.0001), and a significant inverse correlation with SNAP was observed (rs range, −0.37 to −0.71, p < 0.0001). In particular a low b* value for the abdomen was found to be a significant predictor of illness severity (92.6% sensitivity; 96.6% specificity; 96% positive predictive value; 93.7% negative predictive value; adjusted odds ratio, 14.7; 95% confidence interval, 6.4 to 33.8). Our findings indicate that skin color reflects clinical severity in the newborn and that skin colorimetry can accurately identify higher risk infants.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Sun and Skin

The study of the biological effects of sun on the skin is one of the most topical questions in the recent dermatological literature. Interest in these effects has grown since it was demonstrated that the sun accelerates intrinsic skin ageing and is a principal factor for skin cancer. Skin damage caused by the sun is mainly due to UV radiation. Skin damage certainly has ancient roots, but has undergone sudden changes since man began to migrate to different geographical areas, for example when northern European populations colonised sunny areas close to equator. It is not a coincidence that the highest incidence of sun nduced neoplasias is observed among white population of Australia. This epidemiological finding focused the interest towards the identification of phenotypic factors conditioning skin response to sunlight, and hence towards the definition of the so called phototype. After the fundamental work of Fitzpatrick based on sun exposure history more recent studies have shown that skin response to UV-rays can be predicted, to a good approximation, by skin colorimetry. Therefore this simple, cheap and non invasive measurement enables to predict sun reactivity skin type and to evaluate the melanoma risk.

Thalidomide in the Treatment of Kaposi’s Sarcoma

Background: Kaposi’s sarcoma (KS) is a lymphangioproliferative tumour. Therapy of KS depends on the characteristics of the disease, especially area and growth rate of lesions, and patient condition. Currently symptomatic resectable lesions are excised, whereas more advanced disease and unresectable lesions are treated with radiotherapy. If a large area or internal organs are affected or other treatments fail, chemotherapy is used. Recently some authors have reported their encouraging experience in the use of thalidomide in patients with AIDS-related KS. Objective: To evaluate the efficacy of thalidomide in 3 patients with non-AIDS-related KS. Methods: Two patients with classic widespread cutaneous and 1 with iatrogenic cutaneous and visceral KS were treated with thalidomide (100 mg/day) for 12 months. Results: In all 3 patients partial remission was evident after 4 months of thalidomide therapy; in 2 out of 3 complete remission was achieved after 12 months of treatment. Conclusions: Our results seem to confirm the utility of thalidomide in the treatment of non-AIDS-related KS.

Relationship between Skin Color and Sun Exposure History: A Statistical Classification Approach

In this study our aim was to determine the biophysical values of constitutive skin color in Caucasians and to define the correlation between skin color and phototype assessed according to the Fitzpatrick method. Constitutive skin color was measured on the buttock, with a Minolta CR‐200 colorimeter, in a population of 557 consecutive subjects belonging to phototype categories I, II, III and IV. The colorimeter expresses the results in five different color systems. We used the “Yxy” and L*a*b* systems, which are the most widespread in dermatology. Statistical analysis of the data showed that the “Yxy” system is even more discriminant than the L*a*b* system when the Fitzpatrick classification scheme is adopted as the reference and shows a poor ability to correctly classify the intermediate phototypes (II and III). On the contrary the “Yxy” system performs well in distinguishing phototypes I and IV. To establish whether this low discriminating capacity for phototypes II and III is related to a low discriminating capacity of the method suggested by Fitzpatrick or by our procedure, an objective technique (minimal erythemal dose) should be used to evaluate the percentage errors of classification of both the Fitzpatrick method and instrumental measurement of skin color. The results of such a study are extremely important because the evaluation of skin color is objective, simple and has potential applications in dermatology and cosmetology.

A case of cryofibrinogenaemia responsive to stanozolol.

Cryofibrinogen is a plasma protein complex whose presence in the peripheral blood is generally asymptomatic, but may sometimes cause multiple thromboembolism in the skin, lung and myocardium. The pathological manifestations associated with cryofibrinogenaemia have been treated with plasmapheresis and fibrinolytic drugs such as streptokinase, streptodornase and/or urokinase. Good results have recently been reported with stanozolol. This prompted us to treat a patient suffering from cryofibrinogenaemia with this androgenic hormone. The patient was a 66‐year‐old woman with rapidly evolving leg ulcers. Stanozolol was orally administered at 4 mg b.i.d. for 5 months and then gradually reduced. Plasma cryofibrinogen disappeared after 45 d from the start of therapy and cutaneous ulcers healed in 5 months.

Quantitative Characterization and Study of the Relationship between Constitutive‐Facultative Skin Color and Phototype in Caucasians

Abstract In this study constitutive and facultative colorimetric values were quantified to determine the physiologic changes in Caucasian skin color and to define the correlation between skin color and phototype assessed according to the Fitzpatrick method. Our population consisted of 401 subjects ranging in age from 24 to 28 years with similar life styles. Skin color was measured with a Minolta CR‐200 colorimeter on the upper medial quarter of the buttock (constitutive color) and on the cheek (facultative color). Advanced multivariate statistical analysis allowed differentiation between constitutive and facultative skin color in relation to the phototype to be quantified. Moreover, Kullback divergence showed that the probability of correctly determining a subjects phototype is high when the variables of constitutive and facultative skin color are considered together. This interesting result makes it possible, in the future, to use colorimetric values of exposed and nonexposed skin, together with determination of Fitzpatrick phototype and of other phenotypic characters, to better predict cutaneous sun reactivity.

Long term follow-up results on severe recalcitrant atopic dermatitis treated with extracorporeal photochemotherapy.

rounder, and dendrites of LC showed shorter relatively, compared to other subgroups (Fig. 2a–d). The lower panel of Fig. 2 shows there were no obvious active caspase 3-positive cells in the epidermis for all subgroups. TCIs could block T-cell proliferation; however, the carcinogenesis of TCIs remains unsubstantiated. Long-term use of TCIs on exposed parts accompanies solar ultraviolet radiation. Long-term UVB, UVA and SSR all reduce the number of epidermal LC. Epidermal LC play a role of immunosurveillance which is one important pathway against tumorigenesis. They process antigen and migrate to draining lymph nodes, expressing CD1a. Our study found that long-term suberythemal UVB radiation markedly reduced epidermal LC number, and induced more obvious changes in LC morphology; however, topical tacrolimus 0.03% could reverse these changes. The epidermal LC of the tacrolimusonly subgroup had no significant changes, which indicates that the effects of tacrolimus on LC are conditional. There were no obvious active caspase 3-positive cells in the epidermis of all subgroups, which indicates that the possible mechanism for long-term suberythemal UVB-induced epidermal LC reduction does not seem to be apoptosis, and the mechanism by which tacrolimus 0.03% reverses the LC reduction induced by UVB is also not related to apoptosis. LC migration might be the key factor, which needs further investigation.

Relationship between minimal phototoxic dose and skin colour plus sun exposure history: a neural network approach

Before beginning PUVA‐therapy it is important to accurately gauge an individuals degree of psoralen photosensitivity. This determination is usually based on an individuals skin phototype or minimal phototoxic dose. Since minimal phototoxic dose is technically complex and time consuming to measure, sun reactivity skin phototype is often used instead; however, it has recently been shown that skin phototype lacks specificity as a predictor of an individuals minimal phototoxic dose. In this study, an artificial neural network was developed to attempt to predict the minimal phototoxic dose from skin colour measurements combined with skin phototype. Our results showed that minimal phototoxic dose was predicted with an error less than 1 J/cm2 in only about half the subjects. In conclusion, minimal phototoxic dose probably cannot be predicted with sufficient accuracy on the basis of skin colour and skin phototype alone.

Ocular involvement in generalized fixed drug eruption from nimesulide

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